Report (47) /z-/q0ci SCA-) / 6c, t-K ,4- /
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FIRE SAFETY SYSTEMS
AQUASAFErm FLOW TEST
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VERIFICATION
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FORM
1 `
AquaSAFE' Flow Test Verification Form
Alliance Important:Installing contractor must submit this
Member ID: . completed form.Failure to do so nullifies the
/301 41
Company Name.. ' system warranty.E-mail or fax completed form
to the Uponor Fire Safety Design Department7
Contact:
-Z- LA414 •Itt
, at technicatsenfices@tiponor,com or 952.99 .1731.
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Phone:
5S— 6'1
For questions,contact Uponor Technical Services at
888594.7726 or technical,..servicpo_nor.com.
lax: Color of test orifice used:
Job Name: IC.614‘1...re ilr'frei lelitett€- Static pressure(not flowing)reading at incbmir?..,
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Project Number: -20-% water supply into home or at main shutoff:
Job Address:
rjr- .v? rt-7
City: ,..r Residual pressure(flowing)reading at incomingzwater
supply into home or at main shutoff: 5Z.
State,ZIP: .,
0 41- 7241
What time of day was the
flow test .
taken? 2'4.0 t).M,
For designs not provided by Uponor,complete the
Flow test method used?ierucket U Flow Meter
following information.
flow test gpm:
Designer's Name.
How many gallons of water did the design predict
Company.
as required?. /3
Phone: Did the test meet or exceed design flow? Artg J No
Fax: Which sprinkler did you flow?Number: /4,
Is the warning sign permanently attached close to the i()cation ofhead.
main shutoff valve? F.3 Yes U No
Date left in service with all valves open: _
Was this system required by code?U Yes U No
13
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Test Witnessed and Verified by:
isSignature ••••,......111...., Occupation Date
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Additional Explanations and Notes
1
Uponor,Inc, Tel:800321.4739
5925 148th Street West 952.997.1731
4.1 Apple Valley,MN 55124 USA Web:www.uponor-usa.com